Victoria

As is the case elsewhere in Australia, Victoria has seen a trend over the last ten years to more babies being born before 40 weeks. Between 2007 and 2017, the overall preterm birth rate (births before 37 weeks) in singleton pregnancies rose slightly, from 5.9% to 6.4%.

This increase occurred only in those babies born between 34 and 37 weeks (4.4% rising to 4.9%), with the rate of births prior to 34 weeks remaining stable at 1.5%. The spontaneous preterm birth rate over this same time period actually decreased, from 3.4% to 2.8%, and so it was the increase in iatrogenic (medically-initiated) early births from 2.5% to 3.6% that was responsible for the overall rise in the preterm birth rate.

Many of these preterm births will have been medically indicated, as the best way of managing complications of pregnancy affecting the mother, baby, or both. However, the overall incidence of two pregnancy complications that are common indications for early delivery – small for gestational age babies and maternal high blood pressure – has decreased over this decade, while the proportion of preterm birth in these conditions has increased. These data suggest that some babies are being born earlier than necessary.

    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
    
 

In 2019, Safer Care Victoria launched the Safer Baby Collaborative – a statewide quality initiative involving 22 health services that employs the Institute for Healthcare Improvement’s proven model for improvement (https://www.bettersafercare.vic.gov.au/our-work/clinical-improvement-and-innovation/reducing-stillbirth). Derived from the Stillbirth Centre of Research Excellence Safer Baby Bundle, the focus of the collaborative is a reduction in stillbirths, but two of its core components are also directly relevant to reducing rates of preterm birth:

• Smoking cessation in pregnancy, using innovative technologies such as carbon monoxide monitors in antenatal clinics
• Promoting appropriate timing of birth and mitigating unintended consequences or harm, through encouraging care providers and patients to initiate conversations about the optimal gestation at which birth should occur, which in most cases should not be before 39 weeks.

The improvement model used in this collaborative is generating a large volume of data regarding which strategies are effective in different settings. In 2020, we will use these data to inform the design of additional initiatives to promote the importance of The Whole Nine Months among maternity care providers and patients alike.

The development of the Safer Care Victoria Maternity eHandbook (https://www.bettersafercare.vic.gov.au/resources/clinical-guidance/maternity-ehandbook) has given us the opportunity to promote a consistent approach to the identification and management of women at risk of spontaneous preterm birth, through guidelines that highlight the importance of risk stratification from the start of pregnancy, and the role of evidence-based treatments to reduce the chance of early preterm birth.

Finally, our statewide ‘clinical dashboard’ gives health services the opportunity to review, in real time, absolute rates and trends of important perinatal indicators such as preterm birth, rather than having to wait for annualised reports. This allows for more timely local responses to rates or trends that are of concern.

• Adjunct Professor Tanya Farrell
• Associate Professor Jeanie Cheong
• Professor Jeremy Oats
• Dr Stefan Kane